Lynn Anne M, Nespeca Mary Kay, Bratton Susan L, Shen Danny D
Department of Anesthesiology, University of Washington Schools of Medicine and Pharmacy, Seattle, WA, USA Department of Anesthesia and Critical Care, Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA Department of Pharmaceutics, University of Washington Schools of Medicine and Pharmacy, Seattle, WA, USA.
Pain. 2000 Oct;88(1):89-95. doi: 10.1016/S0304-3959(00)00313-4.
Eighty-three infants received i.v. morphine following surgery as a continuous infusion to a targeted morphine concentration of 20 ng ml(-1) (n = 56) or as intermittent bolus doses as needed (n = 27). Ventilation was compared in the two groups by continuous pulse oximetry, by venous blood gases on postoperative day 1 (POD 1) and by CO2 response curves. Infant pain scores were done to assess analgesia every 4 h. Both groups achieved pain scores consistent with analgesia but the bolus group showed a higher percentage of pain scores indicating distress (32 vs. 13%, P < 0.001). Room air saturations of < 90% were seen for 2.3% of POD1 in infusion-treated infants and for 2.5% of POD1 in bolus-treated infants. Mean venous PCO2S were normal in the two groups. Four infants showed ventilatory effects in the infusion group (4/ 56 = 7%); venous hypercarbia in two (2 days, 36 days), oximetry desaturation in one (240 days), both effects in one (6 days). Ventilatory effects were not statistically different between the intermittent bolus-treated and infusion-treated infants but may be clinically important. Monitoring with continuous oximetry is necessary. Morphine clearance increased with age. Infants with detectable morphine also had measurable morphine-6-glucuronide in both groups. Oral intake began at 16 h in both groups and other side effects were infrequent.
83名婴儿在手术后接受静脉注射吗啡，其中56名婴儿采用持续输注方式使吗啡浓度达到目标值20 ng/ml⁻¹，27名婴儿根据需要采用间歇性推注给药。通过连续脉搏血氧饱和度监测、术后第1天（POD 1）的静脉血气分析以及二氧化碳反应曲线对两组的通气情况进行比较。每4小时进行一次婴儿疼痛评分以评估镇痛效果。两组的疼痛评分均表明镇痛有效，但推注组中显示痛苦的疼痛评分百分比更高（32%对13%，P<0.001）。输注治疗的婴儿在POD1期间有2.3%出现室内空气饱和度<90%的情况，推注治疗的婴儿在POD1期间有2.5%出现这种情况。两组的平均静脉血PCO₂均正常。输注组有4名婴儿出现通气影响（4/56 = 7%）；2名出现静脉血高碳酸血症（分别为2天、36天），1名出现血氧饱和度下降（240天），1名同时出现两种情况（6天）。间歇性推注治疗和输注治疗的婴儿之间通气影响无统计学差异，但可能具有临床重要性。需要进行连续血氧饱和度监测。吗啡清除率随年龄增加。两组中可检测到吗啡的婴儿也都可检测到吗啡-6-葡萄糖醛酸。两组均在16小时开始经口摄入，其他副作用不常见。
